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"It Was Always There" - Yael Danieli
 

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    "It Was Always There" - Yael Danieli "It Was Always There" - Yael Danieli Document Transcript

    • 37 It Was Always There Yael Danieli Several interacting arcs of events and people trace the development of my interest in trauma. The first is my growing up on a Kibbutz, then in Tel-Aviv, under British mandate prior to Israel’s birth in 1948, then through the building of Israel and the ensuing wars. I remember clearly the sense of extended family and community in the Kibbutz in particular and in the country in general; the total idealism and willing sacrifice, commitment and determination, and joy in building our own state. But the British mandate meant, for example, that we couldn’t have lights on at night for fear of attacks and that, in a country where the sun doesn’t set often until after 8:00 p.m., a curfew did not allow us to be outdoors from 6:00 p.m. to 6:00 a.m. I still carry the legacy of these curfews, the sense of oppression and resentment, the small ways we children rebelled against the British mandate, our attempts to mask anxiety and fear, and our ever- strengthened commitment to become, in time, almost characterological. I also remember being awakened on a New Years Eve by British soldiers singing Auld Lang Syne. My mother told me that they were lonely and missed their wives, children, and parents, which helped to humanize “the enemy.” During the same time, news of the Holocaust was seeping in. Almost everyone around me had come to Palestine from Europe as a pioneer, leaving family members behind. Disbelief and attempted denial gave way to shock, palpable concern, dread and anticipatory grief. Some survivors who tried to reach the shores of Israel were re-interned by the British in concentration camps in Cyprus. Others who reached Israel were sent immediately to fight her War of
    • 38 Independence, and were killed. Most were welcomed to share in building their new, free land for the Jewish people, where such a slaughter will “never happen again.” Intended as a powerful positive message, “never again” also concealed disdain and contempt for, and (related) guilt toward the victims and the survivors (Danieli, 1982a) that existed at least until the Eichmann trial in 1962. Since my childhood, survivors were my teachers of trauma and its aftermath. Complexity was present at all times: The themes of rebirth, renewal, resilience and hope; danger, vulnerability, and sadness but never without humor and joy, sometimes to the detriment of necessary mourning. But “Yom Hashoah,” the national annual day of collective observance and commemoration rituals, has united all citizens in shared grief and sorrow. This complexity foretold the understanding, also in my framework (see below), that vulnerability and resilience exist simultaneously rather than being mutually exclusive, as some in the field have held. Then came the “aliah” (immigration) of refugees from the Arab countries. We were recruited, as teenagers, to help them integrate into the culture. For example, my classmates and I taught refugee women how to use a sewing machine. Israel’s wisdom in involving the children in the upbringing of the country and appreciating its multiculturalism cannot be overstated. Many of these memories are not in themselves traumatic or traumatogenic, but they did shape my thinking, consciously and unconsciously, about post-trauma (re)building of societies that I was to become involved in later in South Africa, Bosnia and Rwanda, among others. The more direct intellectual arc began when I chose the phenomenology of hope as the initial topic of my doctoral dissertation at New York University. (Ironically, it was my Christian doctoral advisor, Robert R. Holt, who reminded me that hope was the Israeli anthem.) For this study, I conducted in-depth interviews with people whose hope had been challenged in situations
    • 39 ranging from the seemingly trivial (missing a bus) to the extreme (concentration camps, terminal illness, war imprisonment). I remember colleagues uniformly discouraging me from interviewing Holocaust survivors: “They don’t talk to anybody.” This proved to be as far from my experience as possible. Typically, I would come to a survivor’s home (to study people in their own environment) after work. They would seat me in the kitchen, and they would talk nonstop, sometimes until the next morning. They had been waiting for someone who would listen. Every survivor, without exception, said that no one would listen to or believe their Holocaust experiences. This pervasive postwar societal reaction led them to conclude that no one who had not gone through the same experience could understand, and thus to opt for silence. Their children recounted similar experiences. Even more striking and shattering to me as an idealistic graduate student of clinical psychology, they said that psychotherapists too would not listen, thereby participating in what I consequently termed the conspiracy of silence. My pained outrage at the survivors’ resulting sense of isolation and betrayal has been channeled into all aspects of my professional work since: research, clinical, theoretical, teaching/training, organizational and advocacy. As a researcher, I focused on studying the phenomenon of the conspiracy of silence, its origins, meanings, and aftermath. That resulted in two main bodies of literature. The first was therapists’ difficulties in treating survivors of the Nazi Holocaust and Their Children, or countertransference (for lack of a better word then), which became the new topic of my doctoral dissertation (Danieli, 1982a). I was motivated first by my realization that whereas society has a moral obligation to share its members’ pain, psychotherapists and researchers have, in addition, a professional contractual obligation. When we fail to listen, explore, understand, and help, we too
    • 40 inflict the “trauma after the trauma” (Rappaport, 1968), or “The ‘second injury’ to Victims” (Symonds, 1980) by maintaining the conspiracy of silence. I also believed that studying experienced, well-analyzed, introspective professionals would provide insights into the larger societal, and bystanders’, conspiracy of silence. In order of frequency, some of the major categories of countertransference phenomena systematically examined in my study were: 1. Various modes of defense against listening to Holocaust experiences and against therapists’ inability to contain their intense emotional reactions (e.g., numbing, denial, avoidance, distancing, clinging to professional role, reduction to method and/or theory); 2. Affective reactions such as bystander’s guilt; rage, with its variety of objects; dread and horror; shame and related emotions (e.g., disgust and loathing); grief and mourning; “me too”; sense of bond; privileged voyeurism; and 3. Specific relational context issues such as parent-child relationship; victim/liberator; viewing the survivor as hero; and attention and attitudes toward Jewish identity. These themes are reported, described, illustrated, and discussed in detail in a series of articles (Danieli, 1980, 1984, 1988a, 1994). The findings include a comparison between psychotherapists who were survivors or children of survivors and those who were not. Many of the reactions were found to be to patients' Holocaust stories rather than to their behavior. The unusual uniformity of psychotherapists' reactions suggested that they were in response to the Holocaust, the one fact that all the otherwise different patients have in common. I therefore suggested that it is appropriate to name them countertransference reactions to the Holocaust (the trauma event/s), rather than to the patients themselves, and noted their similarity “to alexithymia, anhedonia, and their concomitants and components which, according to Krystal, characterize
    • 41 survivors" (Danieli, 1981, p. 201). Extending the term to reflect that therapists' difficulties in treating other victim/survivors populations may similarly have their roots in the nature of their victimization, I suggested the term event countertransference. At the same time, in an initial session, SL, a frail, agitated young man intermittently interrupted his incoherent rambling with a refrain-like phrase "my mother gave me gray milk," that not only became a leitmotif of his therapy but also formed an indelible metaphor portending the development of my thinking and understanding of the what and the how of transmission of the effects of the Holocaust in particular and of trauma in general. His "very old." father was "from Auschwitz," the sole survivor of a family that had included a wife and two sons who perished in the ovens. SL was named after his murdered half-brothers. His father met SL's 17-year younger "beautiful" mother upon arriving in the United States. SL believed that, although American-born, his mother must have absorbed ashes from his father, and passed them to him through her milk. For years, as myriad survivors and their children attempted to break the conspiracy of silence with me, I relived with them that alarming sense combined of acute pain, flooding helplessness and outrage, particularly when conceiving their pain as "Hitler's posthumous victory." The other body of literature was on the dialectical relationship between the aftermath of the Holocaust and post-Holocaust conspiracy of silence as it affected survivors (and their children) throughout their life cycle, particularly in times of even normal transitions which they nonetheless tend to experience as a return of or further trauma. This kind of analysis requires a lifelong and multigenerational perspective, and an in-depth exploration of processes such as mourning, separation, survivor’s and bystander’s guilt, rage and shame . I am grateful to Helen Block-Lewis, Judith Herman’s mother, for encouraging me to do such explorations with survivor’s guilt, and Henry Krystal for dialogues on the survivors’ aging process.
    • 42 As a clinician I reached out to other psychotherapists to develop the first program since World War II to provide psychological help for Holocaust survivors and their children. We established the Group Project for Holocaust Survivors and their Children (GPHSC) to counteract their profound sense of isolation and alienation and compensate for their neglect by the mental health professions. Formally begun in 1975 by volunteer psychotherapists in the New York City area, led by Lisette Lamon-Fink and myself, GPHSC recognized the vital importance of mutual and self-help and has capitalized on group and community modalities from its inception. Survivors could at last talk about their memories and experiences, explore with each other and comprehend the long-term consequences in their lives of the Holocaust and the conspiracy of silence that followed it, and share their feelings and current concerns (Danieli, 1982a). Group and community therapeutic modalities also affirm the central role of “we-ness” and the need for a collective search for meaningful response (Danieli, 1985c) and help rebuild a sense of extended family and community, which were lost during the Holocaust. In addition, they have helped psychotherapists compensate for and modulate their own difficulties in treating survivors and children of survivors. Whereas a therapist alone may feel unable to provide a “holding environment” (Winnicott, 1965) for his or her patient’s feelings, the group as a unit is able to. The group functions as an ideal absorptive entity for abreaction and catharsis of emotions, especially negative ones that are otherwise experienced as uncontainable. The Project’s goals, which are preventive as well as reparative, are predicated on two major assumptions: (1) that integration of Holocaust experiences into the totality of the survivors’ and their children’s lives, and awareness of the meaning of post-Holocaust adaptational styles (see below) will be liberating from the trauma and facilitate mental health
    • 43 and self-actualization for both; and (2) that awareness of transmitted intergenerational processes will inhibit transmission of pathology to succeeding generations. In the context of teaching/training, it is important to emphasize that event countertransference reactions may inhibit professionals even from studying, certainly from correctly diagnosing and treating, the effects of trauma. Recognizing the grave need for training, the GPHSC has provided short- and long-term Countertransference and Training seminars and individual supervision to professionals since 1975. Regarding event countertransferences as dimensions of a professional’s inner, or intrapsychic, conspiracy of silence about the trauma allows us to explore and confront these reactions to the trauma events prior to and independent of the therapeutic encounter with the victim/survivor patient. To work through event countertransference, I gradually developed an exercise process (Danieli, 1994) that has been proven helpful in numerous workshops, training institutes, “debriefing” of "front liners,” short- and long-term seminars, and in consultative, short- and long-term supervisory relationships around the world. Ameliorating these reactions in bystanders may lessen the societal conspiracy of silence as well. The giants in the field of the psychiatric effects of the Holocaust on its survivors, the originators of some of the central concepts of our thinking to this day, the survivor’s syndrome, survivor’s guilt, psychic numbing among other -- Henry Krystal, William Niederland, Leo Eitinger, Edie de Wind, Robert Jay Lifton -- most influenced and generously taught me when no other means of training existed. When I entered the field, indeed the only diagnostic term used was the “survivor’s syndrome,” and it was applied rather indiscriminately to all cases of survivors, even extended to the expectation that children of survivors would manifest a single transmitted "child-of-survivor syndrome" (e.g., Phillips, 1978). What I saw were heterogeneous,
    • 44 life-long and intergenerational familial styles of adaptation. Choosing the family rather than the individual as the unit of analysis, I delineated a typology of four post-traumatic adaptational styles: The victim families, the fighter families, the numb families and families of “those who made it.” The heterogeneity of responses of families of survivors to their Holocaust and post- Holocaust life experiences, beyond notions of the survivor’s syndrome and of post-traumatic stress disorder, emphasizes the need to guard against expecting all victim/survivors to behave in a uniform fashion and to match appropriate therapeutic interventions to particular forms of reaction. The multigenerational work culminated in the publication in 1998 of the “International Handbook of Multigenerational Legacies of Trauma” for which I commissioned a worldwide network of researchers, clinicians and scholars from 32 populations around the world, many for the first time, to contribute. They included the Nazi Holocaust, World War II, genocide, the Vietnam war; intergenerational effects revealed after the fall of Communism, in indigenous peoples, following repressive regimes, crime and urban violence, infectious and life-threatening diseases, and the emerging biology of intergenerational trauma. The book established the universal existence of intergenerational transmission of trauma and its effects and validated the concerns shared by many experts. In the past, multigenerational transmission had been treated as a secondary phenomenon, perhaps because it is not as obviously dramatic as the horrific images of traumatized people. Recoiling when viewing such images, particularly of victimized children today, the mind does not take in that children not yet born could inherit a legacy and memories not of their own but that will shape their lives nevertheless. That the same images may shape the lives of generations to come, sometimes unconsciously, often by design, is even harder to comprehend and accept.
    • 45 Given a life-time Posttraumatic Stress Disorder (PTSD) rate of 7.8% in the US general population (Kessler, et al., 1995) it is a relatively common psychiatric disorder; even if only a minority is or will be involved in parenting, the number of children upon whom intergenerational effects will have an impact is enormous. In other groups and societies, where the rates of trauma exposure are much higher, an even greater proportion of the population is affected, with consequent intergenerational implications. Applying the lessons from my work with survivors and children of survivors of the Nazi Holocaust, I have expanded to victim/survivors of other genocides and human-made massive trauma. I served as consultant to South Africa’s Truth and Reconciliation Commission, and to the Rwandan government, among others, on reparations for victims. It grew to working with Rwanda’s victims. I have also led a long-term project in the former Yugoslavia which I had named “Promoting a Dialogue” and the local participants named much more appropriately, “Democracy Cannot Be Built with the Hands of Broken Souls.” IBUKA, the Rwandan umbrella organization for victims of the genocide, asked me in 1999 to help bring Holocaust survivors there to “teach [us] how to live after death.” This request led to the historic first meeting of all Holocaust and genocide groups in Kigali, Rwanda in November, 2001, where we created together the International Network of Survivors and Friends of Survivors of Holocaust and Genocide. Closing the meeting I suggested that one of the lessons I have learned is to drop the "n" in never again. The headlines of today's newspapers tell us why. As a theorist, I struggled to delineate the nature and encompass the extent of the destruction of catastrophic massive trauma, and to account for its different contextual dimensions and levels, and the diversity in and in response to it. I concluded that only a multidimensional, multidisciplinary integrative framework would be adequate. I therefore termed it Trauma and the
    • 46 Continuity of Self: A Multidimensional, Multidisciplinary, Integrative (TCMI) Framework and used it to guide mutual collaborative work with numerous experts in all related disciplines. A summary of the TCMI framework follows (Danieli, 1998, 2003). An individual's identity involves a complex interplay of multiple systems, including the biological and intrapsychic; the interpersonal—familial, social, communal; the ethnic, cultural, ethical, religious, spiritual, natural; the educational/occupational; the material/economic, legal, environmental, political, national and international. These systems coexist along the time dimension, creating a continuous sense of life from past through present to the future. Ideally, one should have free psychological access to and movement within all these identity systems. Each system is the focus of one or more disciplines that may overlap and interact, such as biology, psychology, sociology, economics, law, anthropology, religious studies, and philosophy. Each discipline has its own views of human nature and it is those that inform what the professional thinks and does. The (TCMI) framework will thus help guard against the reductionistic impulse to find unidimensional explanations for such complex phenomena. Trauma Exposure and "Fixity" Trauma exposure can cause a rupture, a possible regression, and a state of being "stuck" in this free flow, which Danieli (1998) has called “fixity.” The intent, time, place, duration, extent and meaning of the trauma for the individual and the survival strategies used to adapt to it will determine the degree of rupture and the severity of the fixity. Fixity can be intensified in particular by the conspiracy of silence, the survivors' reaction to the societal indifference, avoidance, repression, and denial of the survivors' trauma experiences. The conspiracy of silence is detrimental to the survivors' familial and sociocultural (re)integration by intensifying their already profound sense of isolation and mistrust of society.
    • 47 It further impedes the possibility of their intrapsychic integration and healing, and makes the task of mourning their losses impossible. Fixity may increase vulnerability to further trauma and may also render immediate reactions to trauma (e.g., acute stress disorder) chronic. Particularly in the extreme, it may become life-long (Danieli, 1997) post-trauma/victimization adaptational styles (Danieli, 1985), when survival strategies generalize to a way of life and become an integral part of one's personality, repertoire of defense, or character armor. These effects may also become intergenerational in that they affect families, prior and succeeding generations. In addition, they may affect groups, communities, societies and nations. Other researchers (Rich, 1982; Klein, 1987; and Sigal and Weinfeld, 1989) have validated my descriptions (Danieli, 1985) of at least four differing post-Holocaust adaptational styles of survivors' families: The recognition of the possible long-term impact of trauma on one’s personality and adaptation and the intergenerational transmission of victimization-related pathology still await explicit inclusion in future editions of the diagnostic nomenclature. Until they are included, the behavior of some survivors, and some children of survivors, may be misdiagnosed, its etiology misunderstood, and its treatment, at best, incomplete. This framework allows evaluation of each system's degree of rupture or resilience, and thus informs the choice and development of optimal multilevel intervention. Repairing the rupture and thereby freeing the flow rarely means "going back to normal." Clinging to the possibility of "returning to normal" may indicate denial of the survivors' experiences and thereby fixity. Integration of the trauma must take place in all of life's relevant systems and cannot be accomplished by the individual alone. Systems can change and recover independently of other systems. Rupture repair may be needed in all systems of the survivor, in his or her community
    • 48 and nation, and in their place in the international community. To fulfill the reparative and preventive goals of trauma recovery, perspective, and integration through awareness and containment must be established so that one's sense of continuity and belongingness is restored. To be healing, even self-actualizing, the integration of traumatic experiences must be examined from the perspective of the totality of the trauma survivor's family and community members. The proposed diagnoses of “complex PTSD” (Herman, 1992) and “disorder of extreme stress not otherwise specified” (DESNOS; Roth, et al., 1997) that were considered for but not included in DSM-IV (APA, 1994) represent attempts to go beyond the basic 17 symptoms of PTSD and associated features. Although several of the DESNOS descriptions, such as survivor’s guilt, are included as associated features of PTSD, many believe that it is a construct in its own right. Similarly to Danieli (see the TCMI Framework above), the descriptions of complex PTSD and DESNOS emphasize profound personality changes following repeated exposure to man-made traumata; these are allowed in the current DSM only as associated features but not as a distinct diagnosis, and recognize alterations in the survivor’s world assumptions and values. In each of these instances, however, the entity represents a hybrid that mixes aspects typically conceptualized as belonging to Axis I (clinical syndromes defined by the presence of specific symptom constellations) and Axis II (personality disorders—"enduring pattern of inner experience and behavior that 
 is pervasive and inflexible 
 is stable over time, and leads to distress or impairment” [DSM-IV, p. 629]). The ICD-10 (WHO, 1992) category of “enduring personality change after catastrophic experience” is more consistent with my notion of post- trauma/victimization adaptational styles, but its description focuses on adjustment rather than
    • 49 adaptation, and is far narrower than mine. Additional systematic research is needed to document in detail the long-term course of the aftermath of repeated exposure to man-made traumata. Organizationally, I have been privileged to take part in the forefront of two pioneer organizations representing differing yet related perspectives on victims: Victimology was born out of criminology to balance the rights of the victims with those of the accused or offender, and led to the birth in 1979 of the World Society of Victimology. The modern history of traumatology, with its focus on the psychosocial, emotional, and psychobiological reactions to traumatic events, is a 1980s offshoot of mental health, in particular, the Scientific Committee on the Mental Health Needs of Victims of the World Federation for Mental Health, and led to the birth of the (very quickly, International Society for Traumatic Stress Studies in 1985, a mere five years after the diagnosis of PTSD. As one of the founders of the ISTSS, and its third (1988-1989) President, this society has been an integral part of my life for the last 20 years. Having the Society represent as many victim populations and concerns, become the heretofore absent voice of teaching/training on the effects of trauma, and universalize its vision as much as possible were three of my missions. Having established the Chaim Danieli Young Professional Award for excellence in service and research, in memory of my father, to encourage them in furthering their work, as President, I commissioned over 200 members of the Society to contribute to the Initial Report of The (1989) Presidential Task Force on Curriculum, Education, and Training (see Danieli and Krystal, 1989). This Report contained model curricula in psychiatry, psychology, social work, nursing, creative arts therapy, clergy and media; organizations, institutions and public health; paraprofessionals and other professionals; and undergraduate education. The report was adopted by the UN (E/AC.57/1990/NGO.3). I also established the ISTSS’ consultative status with the UN,
    • 50 initiated the concept of world meetings, and served as the International Chair of its first world meeting in Amsterdam, the Netherlands in June, 1992. I view informed advocacy as teaching extended to the world (my work has been translated into at least 12 languages). Sometimes, however, I think of an effective lobbyist as a mixture of a missionary and a pest. In terms of advocacy, my efforts to bring what I had learned and was continuously learning to the international community in a more formal way began when, in the early 1980s, Eugene Brody, then Secretary-General of the World Federation for Mental Health, asked me to represent the Federation at the United Nations. My international self was definitely tempted. However, being Israeli, I doubted that I could have much impact at the UN. I told him that I would give it six months and, if proved effective, I would continue. My first involvement in the NGO world at the UN led to serving as vice-chair of the Executive Committee on Non- Governmental Organizations associated with the UN Department of Public Information and Chair of its Publications Committee. Since that time, I have worked at and with the United Nations - with varying degrees of satisfaction and frustration – through informed advocacy to bring mental health and trauma concerns to the UN, and the UN to the fields of mental health and trauma. As a founding member, later Chair, of the WFMH Scientific Committee on the Mental Health Needs of Victims, initially under the guiding wing of Irene Melup of the then UN Crime Prevention and Criminal Justice Branch, and with the continuous friendship of Roger Clark of Rutgers University School of Law, I have participated in developing, drafting, promoting, adapting and implementing all UN instruments relating to victims. Most notably, these have been the UN Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power
    • 51 (40/34) and all subsequent resolutions related to it; Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law and Serious Violations of International Humanitarian Law; and the establishment of and the victims' role in the International Criminal Court, which is its most unique feature and most important contribution to international law. My lawyer friends say that I have drafted more laws than most lawyers. I have served as Consultant to the United Nations Crime Prevention and Criminal Justice Branch and on the Board of its International Scientific and Professional Advisory Council and as Vice-chair of Executive Committee of the NGOs on Crime Prevention and Criminal Justice. I have also served as a consultant to UNICEF, the Office of the UN High Commissioner for Human Rights and various governments and media organizations, including Associated Press and CNN, on trauma and victim/survivors’ rights and care. A major goal of all of these efforts has been to assert the commitment of the international community to victims; to combat impunity and adopt provisions under law for justice and redress, acknowledging the victims’ suffering, and securing restitution, compensation, and rehabilitation, satisfaction and guarantees of non-repetition for them. In the following I summarize necessary components for healing in the wake of massive trauma. They emerged from interviews with survivors of the Nazi Holocaust, Japanese and Armenian Americans, victims from Argentina and Chile, and professionals working with them, both in and outside their countries in my study for the expert group drafting the Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law and Serious Violations of International Humanitarian Law (Rev. 1 October, 2004) for the UN Commission of Human Rights. The components are
    • 52 presented as goals and recommendations, organized from the (A) individual, (B) societal, (C) national, and (D) International perspectives, as follows: A. Reestablishment of the victims' equality of value, power, esteem (dignity), the basis of reparation in the society or nation. This is accomplished by, a. compensation, both real and symbolic; b. restitution; c. rehabilitation; d. commemoration. B. Relieving the victim's stigmatization and separation from society. This is accomplished by, a. commemoration; b. memorials to heroism; c. empowerment; d. education. C. Repairing the nations' ability to provide and maintain equal value under law and the provisions of justice. This is accomplished by, a. prosecution; b. apology; c. securing public records; d. education; e. creating national mechanisms for monitoring, conflict resolution and preventive interventions. D. Asserting the commitment of the international community to combat impunity and provide and maintain equal value under law and the provisions of justice and redress. This is accomplished by, a. creating ad hoc and permanent mechanisms for prosecution (e.g., ad hoc Tribunals and ultimately an International Criminal Court); b. securing public records; c. education; d. creating international mechanisms for monitoring, conflict resolution and preventive interventions. I have also edited, for and on behalf of the United Nations, three books. International Responses to Traumatic stress (Danieli, Rodley & Weisaeth, 1996) grew out of the appalling realization of the global scope of trauma and victimization and the necessity of international endeavors on behalf of the victims. For the first time, UN and NGO contributions were treated equally, emphasizing the essential partnership between them. The UN book on the 50th anniversary of the Universal Declaration of Human Rights, examined from the victims' standpoint; and, “Sharing the Front Line and the Back Hills
” (Danieli, 2002), addressed the
    • 53 costs paid by protectors and providers -- peacekeepers, humanitarian aid and justice workers, and the media -- in the midst of crisis, and the responsibilities of their organizations to train and support them before, during and after their missions. (As tragic ironies sometimes do, that book came out on September 13, 2001, and proved directly relevant to many of the caregivers in my home, New York.) Both the advocacy process of creating these books, and the books themselves, have significantly affected the UN’s language, programs and policies and that of many other organizations around the world. Since September 11, 2001, in collaboration with over 260 colleagues around the world and throughout the United States, I have focused on two new books related to terrorism. The first, in keeping with my international perspective, is The Trauma of Terrorism: Sharing Knowledge and Shared Care, An International Handbook. The second, On the Ground After September 11: Mental Health Responses and Practical Knowledge Gained, for me, is a love gift to New York, which has always excited me with its richness, diversity and culture. I have loved living here and being a New Yorker. On September 11, for the first time, I felt toward New York as I have felt my whole life toward Israel and later toward the countless victims around the world I have tried to help: Protective, caring, and committed. All my books were intended to be used in both practical ways, to relieve and prevent suffering and for informed advocacy, as well as to contribute to traumatic stress studies. Authors were recruited from around the world and from many different disciplines, reflecting, in part, various stages of anguish in confronting their subjects, as well as different ways of knowing and means of access. Many belong to the populations they write about, which makes harder their struggle to create enough distance for writing, yet adds authenticity to the words they give voice to. Starting with my human rights book, I began including among the chapters “voices” of actual
    • 54 victim/survivors and their protectors and providers, which not only render the material far more accessible, but also acknowledges that they are the master experts of their experiences, and are partners in our mutual journey of discovery. I am grateful to the more than 500 authors who contributed to my books alone, and to my numerous supervisees, who enriched my understanding. They augment what I have learned from my most important teachers: My patients. One of my mother’s greatest gifts to me was to make history totally alive. The love of history and the commitment to learn from it instilled by both my parents have been a major force in my life. I often wonder whether it led, at least in part, to my interest in multigenerational legacies of trauma, which integrates the psychological and historical perspectives. They also inspired a consuming curiosity about the world and a sense of being a citizen of it. Within the field of traumatic stress, I have found it satisfying that many of my concepts, including the conspiracy of silence and multigenerational transmission of trauma, have become part of the language, and that many concepts from the mental health field in general, and from the field of trauma in particular, have become an integral part of the language at the UN. But much more work needs to be done, especially in terms of international collaboration. I belong to the generation that preceded PTSD. After it was adopted, most everyone seems to have become addicted to the diagnosis. Increasingly, colleagues have been discovering that PTSD did not encompass many of the survivors’ essential experiences. In attempting to correct the situation, including the possible inappropriateness of PTSD for non-western cultures (Engdahl, 2005), the field seems to be returning to the fuller picture that had been provided by the survivor’s syndrome. I would like future trauma scholars to develop further, in research as
    • 55 well as in clinical and theoretical work, both my concept of post-trauma adaptational styles and the heterogeneous typology I have elaborated. Colleagues like Brian Engdahl, Bill Schlenger and John Fairbank have been my generous scientific advisors, with whom I spent numerous hours seeking to bridge the gap between the clinical and the research perspectives. It is essential that the field continues in this direction, particularly in fully recognizing the time dimension and the long-term and multigenerational perspectives and implications in its studies. But it still pains me that what we have learned from the aftermath of the Holocaust is not naturally referred to or included in the thinking and in many writings in the field. I hope this will be remedied. Most importantly, our task must be to do our utmost to teach policy makers, be it locally, nationally and/or internationally, and impress upon them that the consequences of decisions they frequently make with short-term considerations in mind can not only be lifelong but also multigenerational and are in stark contrast to their rhetoric of making the world a safer and better place for our generation, and for generations to come. That the issue is not only how and how many resources they choose to commit to victims’ care, but it is also the untold multidimensional costs -- economic, psychosocial, educational, political, to name but a few -- over time and down through generations that will be incurred if they fail to provide for them. Everything I have learned began with victims/survivors of the Nazi Holocaust and continued with victims/survivors of genocide and other massive traumata all over the world, such as South Africans, Cambodians, Bosnians, Rwandans, and indigenous people. To have been both a witness and a participant in the search for truth about humanity's unremitting shame and harm has left me feeling privileged. Our work calls on us to confront, with our patients and within ourselves, extraordinary human experiences. This confrontation is profoundly humbling
    • 56 in that at all times these experiences challenge our view of the world and test the limits of our humanity (Danieli, 1994b, p. 371). But taking the painful risk of bearing witness does not mean that the world will listen, learn, change, and become a better place. I would like to dedicate this chapter, as I did the Lifetime Achievement award, and the 5th meeting of the Society when I was its President, to all victim/survivors everywhere, whose simple human dignity, moral courage, and profound generosity enable us -- the professionals -- to reach beyond the veil of rage and tears to touch the truth without which no one can be free.
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